The Big Day

Yesterday Bob and I arose at 5am and set out for East Lansing at 5:50. Bob's sedative again worked well and this time I remembered to order caffiene from the 24 hour Starbucks. I was actually able to feel the intestinal mass on Sunday and was a little worried that once again the plan would have to change.

Things were not looking so hot when we got up to M.S.U. Bob was down to 6 pounds, 10 ounces. This is more than a pound lost since his first visit last month. It's also just about half of what his normal (slightly pudgy) weight is. What was extra scary is that he has actually had an appetite over the last 10 days. Dr. Warzee could also feel the intestinal mass. When I left the plan was to repeat the chest radiograph to check for metastasis, repeat the abdominal ultrasound (I wanted to know how much the intestinal mass had progressed) and repeat a CBC. CBC stands for complete blood count. I had run one, with a chemistry panel, last week but he looked a bit anemic to Dr. Warzee and because of the resolving abscess his white cells were a bit high on my CBC. Pending any disasterous findings, surgery would be today.

I was all done by 9:20 and left Bob to Dr. Warzee. After some aimless wandering around downtown, I decided to just head for home. I stopped for some additional caffiene and hit the highway at about 10:30. It was gloomy, rainy and cold. The temperature had actually dropped from the very early morning. Not a pleasant 2 and 1/2 hours, but I was very thankful for the heater and the windshield wipers. And, I got home in time to take a toasty warm shower before work.

I go to work and had a message from Dr. Warzee. The ultrasound showed no change in the intestinal mass (must just be easier to feel because he's sooooo skinny now), but the radiologist felt that the chest mass might actually be in the lung rather than the mediastinum. The mediastinum is the structure that supports the heart, the trachea and the major blood vessels and lymph nodes within the chest. Different surgical approaches are needed for the lung (usually cutting ribs) versus the mediastinum (midline sternotomy - going through the breastbone itself). Would it be OK to perform a CT scan to confirm where it is? Yes.

This morning, I got the news: the mass is in the right cranial lung lobe, but given the size a sternotomy will still be the best approach. Anesthesia will start at 9:00 with the thoracic mass removal first, followed by debulking the leg mass if Bob is still stable.

As soon as I arrived at work I got the second call. The mass was indeed in the right cranial lung lobe. This was removed along with the right middle lung lobe because there were some suspicious nodules there. The mediastinal lymph nodes were too small to locate, but there was adherence to the mediastinum and the cranial vena cava (very major blood vessel). He's recovering from anesthesia and so far is doing well. The debulking was not performed because he was getting cold and there had been a blood pressure drop, but that's perfectly OK by me.

So, Bob's down 1/3 of his lung tissue but also down a very nasty tumor. Not certain yet when he'll be returning home. That's going to depend upon fluid accumulation in the chest, but he's made it this far!